In an effort to improve predictability of results, surgeons have tried all kinds of things to enhance extraction, handling, processing, and reinjection of the harvested fat. Still, even, with these precautions, about half of the fat that is transferred has a meaningful long-term survival and that’s about as good as anyone can get with traditional fat transfer. Thankfully for most patients, half of the transferred fat does very well and we have almost never had to repeat the procedure. Still, it would be nice to be able to offer an even more robust and predictable enhancement. And, that is the promise of stem cells.

In the last few years, scientists have discovered that fat contains a type of stem cell known as adipose-derived regenerative cells (ADRCs). These cells have shown the ability to improve long-term fat graft retention by secreting key growth factors that enhance blood vessel formation and promote cell survival. Cytori Therapeutics, a leader in the area, has developed technology that can isolate and concentrate these stem cells into a so-called cell-enriched fat transfer procedure.

In the latest article published in the February issue of the Annals of Plastic Surgery, the study of this technology in mice revealed after 6- and 9-month intervals that not only was the quality of transferred fat cells improved but the quantity and retention of fat cells had increased two-fold over controls. There is always a trade-off of course and, in this case, the procedure is expected to add about 90 minutes to surgical times along with increased associated costs. But, if studies in humans can match the findings in animals, this could prove to be a very valuable innovation on the horizon. The medical device technology is currently available in Asia and Europe but not yet approved for clinical use in the USA. We’ll keep you posted on the latest updates.

A new twin study published in the Archives of Dermatology last month has demonstrated the hazardous effects of environmental factors on skin aging. According to the  report, 65 pairs of twins were studied for differences in environmental and lifestyle factors that might contribute to wrinkles. The conclusion according to news sources is that these factors, such as smoking, sun exposure, and weight change may play a larger role in facial skin aging than does genetics.

While we clearly agree that sun exposure and smoking are huge factors in causing wrinkles, we have to point out a flaw with this study’s design. Of the 65 pairs of twins, 52 were fraternal twins sharing the same percentage of genes as do non-twin siblings. While fraternal twins share about half their genes, this is nothing close to the identical genetic make-up shared by identical twins. A really revealing result would be if identical twins with different levels of environmental exposure also showed different levels of skin aging. As is, this study is mostly a study of siblings– it can’t fully control for genetic factors and so it doesn’t really tell us anything new at all.

The bottom line is… you can’t change your genetics anyway no matter how big a role they play, at least not yet. The best thing you can still do to prevent poor skin aging is to avoid smoking and sun exposure. And you didn’t need a flawed study to tell you that.

However, LED exposure, like any light energy exposure can also increase the production of free radicals that can injure the skin. Green tea was added to the mix because it contains a potent antioxidant that combats this harmful effect. The results? According to the German study, the same level of wrinkle improvement occurred in only one-tenth the time it took when treated with LED light alone. This underscores the importance of addressing inflammation and free radical injury as part of any effective anti-aging regimen.

WHO elevates tanning beds to top cancer risk

Studies show those who use tanning beds regularly are 8 times more likely to develop melanoma, the most serious type of skin cancer, and the risk of skin cancer is elevated 75% if the sun bed user starts before the age of 30. These findings come as no surprise to most people. My mom used to say even in the ‘80s that “those beds should be called cancer beds!” Moms are smart that way.

But, this news is important because, for years, proponents of tanning beds used the argument that the primarily UVA radiation emitted from tanning beds was less harmful than sunlight which has broader spectrum UV rays.

In fact, while we have long known that UVB rays are harmful, understanding of the harmful effects of UVA radiation has recently grown and is being reflected in changes in sunscreen formulations. So, while some in their invulnerable youths will continue to seek out the tans that only a UV bed can give (just as they’ll continue to smoke and do other things they’ll regret down the road), it can now officially be said that they were warned.

A lot of poorly regulated and even unregulated business is going on in this area of medicine and the bottom line is that you need to do your homework and make sure you know just exactly who is doing what to you. We, at Profiles, are big proponents of taking it slow when it comes to new therapies and technologies because today’s fad may be tomorrow’s problem. But that’s just us. We encourage you to research, ask questions, and treat cosmetic procedures with the respect and seriousness they should merit. If you see a truly qualified practitioner, the chances for a satisfying outcome are extremely high.

That is, until now. After recent years of obscene growth in popularity, the honeymoon will soon be over. Medicis, the makers of the wrinkle filler Restylane, has just announced FDA approval of their Botox rival, called Reloxin (already marketed in Europe under the name Dysport). The company is poised to begin marketing and distributing the product within the next several months.

Not much is known about the newest entrant into the wrinkle-relaxing field. There have been some conflicting reports about its effectiveness compared to Botox. One study suggested that, in a ratio of 3 units of Reloxin to 1 unit of Botox, the new product showed slightly faster onset and appeared to last longer. In another study, though,at a ratio of 2.5 units to 1 unit of Botox, its cosmetic effect appeared to wear off about a month sooner. So, clearly it will take a little tweaking to determine the equivalent dosing to what people are now used to with Botox.

Of interest to everyone, it is thought that Reloxin will be priced about 15% lower than Botox, an especially welcome turn of events in this sour economy. And, other potential competitors are quick on their heels with PurTox (Johnson and Johnson/Mentor) and Xeomin (Merz) on the horizon and predicted to reach market by 2011. While we’re sure there will be a small learning curve, if these products can equal the safety and reliability that Botox has boasted over the years, they will be a very welcome addition to the office-based cosmetic anti-aging market.

Recently there was a great article in the archives of facial plastic surgery that used Picasso’s Girl in the Mirror to discuss body dysmorphic syndome. The author wrote:

“A portrait may represent a subject in many different ways. It can be a literal representation or it can represent a person symbolically. It can capture a person’s physical characteristics and/or attempt to represent their emotions or personality. In the Girl Before a Mirror, Picasso portrays a young woman surveying herself in an oval mirror. The woman in this painting is Marie-Thérèse Walter, one of Picasso’s girlfriends, with whom he lived and had a child, Maya. In this portrait she is examining and inspecting her appearance in a mirror, but Marie-Thérèse and her reflection are not identical. Art critics have suggested that this represents a symbolic duality, that is, 2 different sides of her character. However, closer scrutiny of this painting indicates a woman who sees herself in a distorted way, which resembles what in clinical psychology is termed altered self-recognition.

Picasso often experimented by showing multiple views of an object on the same canvas to convey more information than could be contained in a single, limited view. For example, he has painted the face of Marie-Thérèse in 2 halves, a frontal view and profile view, which enhance one another. The expression on her face unveils a distinct sadness at the image she sees in the mirror staring back at her. In the distorted reflection she sees her nose as long, whereas the lower third of her face is vertically shortened and retrusive. Her almond-shaped eye is seen as a large ellipsoidal rectangle, with the sclera missing. She sees the reflection of her smooth olive skin as blemished and chalky lilac. The left side of her forehead, upper third of her face, and nose reflect a substantial scarlet stain, resembling a port-wine stain. Her full blond hair is reflected as thin and green. In her reflection she observes vertical asymmetry in the position of her breasts, which appear scarred. She sees herself not the way she looks but as a visual fallacy. Her mind has deformed her face and body.

Most clinicians involved in the treatment of patients with facial deformities will encounter the patient who is excessively concerned with a minor or imperceptible defect in their appearance or patients who reveal extreme dissatisfaction despite good treatment results. In cases in which such a preoccupation with appearance causes the patient marked distress in their social or occupational functioning, the patient may have nondelusional dysmorphophobia, also known as body dysmorphic disorder (BDD). The prevalence of BDD is unknown but is thought to be on the order of 1% in the general population. The condition is likely to be underdiagnosed and underrepresented owing to the secrecy of those affected. However, the prevalence has been found to be higher in cosmetic surgery and dermatology clinics (5% to 12%, respectively).

In severe cases of BDD, patients experience self-inflicted mental torture and anguish. Without appropriate diagnosis and psychiatric treatment, these patients are condemned to a life of distress and misery, held captive by the stigma of a perceived deformity. With this painting, Picasso has given form to the terror that such individuals experience, capturing the patient’s torment in a work of art that will last an eternity.

Throughout his life, Picasso remained a researcher and an experimentalist. He said, “Paintings are but research and experiment.” Girl Before a Mirror may seem to the casual onlooker to be a child’s drawing, yet it is a most powerful and meaningful work of art. As Voltaire said, “It is not sufficient to see and to know the beauty of a work; we must feel and be affected by it.”"

Is Botox safe during pregnancy

There was a disturbing article regarding news from Australia about an expectant mother who in 2005 was treated in her first week of pregnancy with a botox rival, Dysport, and gave birth to a baby who was deaf and blind. The report goes on to say that the Australian version of the FDA, released documents last month detailing the case including a report from the manufacturer of Dysport which states there may be a “possible” link with the drugs usage during pregnancy and the unfortunate outcome.

Now for those of you in the states a few things should be known:
1. There are a lack of controlled studies into the effects of Botox on pregnant women and their unborn children, therefore it is impossible to say conclusively either way whether it is safe.
2. For the sake of erring on the side of caution, Botox’s manufacturers recommend that it is not used on either pregnant women or nursing mothers.
3. As with the effects during pregnancy, there is a lack of information on whether Botox injections can pass the toxin into breast milk.

There have been a number of animal studies in rabbits and rodents which show that in high doses, there is a link between botulinum toxin and low birth weight, problems with bone development, and even possible miscarriage. It should be highlighted that the doses used in the animal studies were far more than anyone would get for cosmetic or medicinal purposes.

Here in the US, no physician we know would do botox in a pregnant patient for cosmetic purposes. The reason is simple, if there isn’t enough information to know conclusively that it is not a possibility, it simply is not done. It should be noted again however, that if you have had botox recently and now find out that you are pregnant, the chances of this being a problem is exceedingly low- the amount of botox normally injected is simply not enough to circulate and cross the placenta in a high enough concentration to cause any problems. In fact, there is one case study out of Tennessee of a woman with cervical dystonia, a muscular disorder, who underwent 4 apparently uncomplicated full term pregnancies while receiving botox treatments regularly for her disorder.

The point is while there is little chance of this being a problem, if you are pregnant or thinking of becoming pregnant in the near future you should tell your doctor before undergoing any treatment.